MEDICARE: DR. TIMOTHY JAMES CITRO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7579	AZ

General Provider Information

NPI Number	:	1306886312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES CITRO DC

Provider Business Mailing Address
First Line	:	6445 S 12TH AVE
Second Line	:	STE 151
City	:	TUCSON
State	:	AZ
Zip	:	85706
Country	:	US
Telephone Number	:	520-294-6200
Fax Number	:	520-294-6201

Provider Business Practice Location Address
First Line	:	6445 S 12TH AVE
Second Line	:	STE 151
City	:	TUCSON
State	:	AZ
Zip	:	85706
Country	:	US
Telephone Number	:	520-294-6200
Fax Number	:	520-294-6201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/28/2007

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